9,100 research outputs found

    UMSL Bulletin 2023-2024

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    The 2023-2024 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1088/thumbnail.jp

    Graduate Catalog of Studies, 2023-2024

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    Approaching Trans Healthcare Competency: The Implementation of Trans Health Education for Medical Providers in Appalachia

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    Barriers to competent and safe healthcare disproportionately impact people who are marginalized because of their race, ethnicity, gender, or socioeconomic status. It is well documented that transgender patients in particular experience barriers to both accessing care and receiving high quality, non-discriminatory care (Hatzenbuehler & Pachankis, 2016; James et al., 2016; Rahman et al., 2019; Safer et al., 2016). This lack of access to culturally competent healthcare services contributes to health disparities that disproportionately impact the trans community. Literature on barriers to competent care for trans patients indicates that providers experience discomfort related to their ability to provide competent care (Safer et al., 2016). Many providers endorse a median of only five hours of trans healthcare training across their entire medical school curriculum (Hughto et al., 2015), and in some cases, as little as 45 minutes per year (Sawning et al., 2017). Primary care clinics should be the place in which general health and wellbeing are addressed for trans patients, as has been true for cisgender people. Primary care providers should be competent in assessing eligibility for Hormone Replacement Therapy (HRT) and surgery (Wylie et al., 2016), as well as providing necessary preventative care. Thus, this makes primary care the ideal setting for the proposed medical education implementation project. The current study aimed to develop and implement a training program for medical residents in primary care in rural South Central Appalachia. A six-stage development and implementation study is described. The intervention was evaluated for pedagogical outcomes including sustainability for future use, usefulness to residents, and accessibility. Evaluation of effectiveness included analyses of changes in providers’ self-reported competency, awareness of discriminatory experiences, and attitudes towards treating trans patients. There were no significant differences in pre-post competency scores (r=22, M=33.29[SD=5.96]; r=31, M=37.33[SD=1.02], SD=8.00) or in pre-post attitudes scores (r=15, M=32.76[SE=0.8], SD=4.69; r=13, M=34.7273[SE=1.00], SD=4.692). Accessibility and sustainability were measured qualitatively and included data such as resident attendance and ease of use of material for future behavioral health provider trainers. These outcomes were found to be satisfactory based on stakeholder feedback. Usefulness included three data points (satisfaction, helpfulness, value of training)

    Emotion regulation as a transdiagnostic construct : novel approaches to psychiatric diagnostics

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    Diagnostic co-occurrence among mental health problems is common. It has been suggested that more research which incorporates analysis on the symptom level and cuts across categorical diagnostic boundaries is needed. This type of transdiagnostic research could have the potential to further increase our understanding of psychopathology and how we can improve treatment outcomes. Emotion regulation is one transdiagnostic process which is thought to be of relevance to several types of mental health problems. These problems include eating disorders and substance use disorders, two areas that both show a significant overlap and are associated with emotion regulation difficulties. The current thesis thus aimed to contribute to the further understanding of (a) symptom-level change and (b) measurement of emotion regulation and its role across different levels of mental health problems (with a focus on eating- and substance use disorders). The aim of Study I was to investigate symptom change over time, by assessing if treatment-seeking adults with eating disorders (N = 3159) demonstrated “symptom shifting” (simultaneously decreasing in some symptoms whilst increasing in others). Individuals demonstrating symptom shifting were then compared to nonshifting individuals on various indicators of mental illness. In the sample, 13% were found to demonstrate symptom shifting among eating disorder-related behaviors. The proportion of patients with symptom shifting increased to 19% when including shifts to deliberate self-harm or substance use (in addition to eating disorder-related behaviors). Individuals with symptom shifting reported significantly higher levels of other psychiatric symptoms (such as depression and anxiety), clinical impairment, and emotion regulation difficulties compared to nonshifting individuals. It was concluded that individuals with symptom shifting could be a group in need of tailored monitoring in clinical practice, as well as treatment approaches targeting several types of risky behaviors. The aim of Study II was to further investigate symptom change over time, by investigating if symptom shifting occurred between symptoms of eating- and substance use disorders in a general population sample (N = 3315). Individuals with symptom shifting were also compared to other individuals with different temporal symptom profiles. A small group of individuals (2% of the whole sample) demonstrated symptom shifting (which represented 10% of individuals who suffered persistent problems in any or both areas). Individuals with symptom shifting reported higher levels of psychiatric symptoms (such as depression, anxiety, suicidality) and demonstrated higher polygenic risk scores for psychiatric disorders. Levels were comparable to individuals who suffered persistent co-occurring problems with eating- and substance use disorder symptoms over time. The results contribute to the understanding of the overlap between eating- and substance use disorders, and again highlight the need for health care services and treatments that address several problem areas simultaneously. The aim of Study III was to evaluate psychometric properties and contrast two of the most used measures of emotion regulation, for which a community sample of adults residing in the US was used (N = 843). The Emotion Regulation Questionnaire (ERQ) and the Difficulties in Emotion Regulation Scale (DERS; including its short form DERS-16) were evaluated using correlations and confirmatory factor analyses. The measures were found to converge in expected ways. Satisfactory fits were found for the ERQ and DERS- 16, but not for the original DERS. The DERS showed greater concurrent validity with psychiatric symptoms (depression, anxiety, stress, substance use) than the ERQ. It was concluded that the validity of both measures to assess emotion regulation was supported, and that the DERS-16 with its shorter format is a clinically useful tool to assess emotion regulation in practice. The aim of Study IV was to investigate the relationship between emotion regulation difficulties across different levels of substance use, and the role of co-occurring psychiatric symptoms. Data from two main sources were used, including the community sample in Study III (n = 843) and two substance use disorder populations from residential treatment clinics in the US (n = 415). Emotion regulation was significantly associated with both substance use frequency and severity across a variety of substances. Of the different facets of emotion regulation (DERS subscales), difficulties controlling impulsive behaviors was found to be specifically associated with greater substance use severity. No significant moderating effect of psychiatric symptoms (depression, anxiety, stress) was found. Results suggested that emotion regulation difficulties are of increasing relevance across the spectrum of substance use, from no use, to misuse, to poly-substance dependence. The studies could contribute to method development in the area of symptom-level change and furthers our understanding of emotion regulation as a relevant transdiagnostic construct. They also could contribute by highlighting important clinically relevant outcomes (such as symptom shifting), which could have potential implications in psychiatric research and clinical practice/health care. Studying common functions of risky behaviors, such as eating disorder-related behaviors, substance use, and deliberate self-harm, from an emotion regulation perspective is suggested to be of importance to consider in future research

    A Transcendental Phenomenological Study: Examining Interprofessional Clinical Learning Experiences to Define the Essential Activities That Will Provide Student Transformation

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    The purpose of this transcendental phenomenological study was to describe the interprofessional education clinical experiences that pharmacy preceptors provide to Doctor of Pharmacy (PharmD) students during the final year of training within four different academic institutions. The theory guiding this study was Kolb’s Experiential Learning Model (ELM) and its four components comprised of concrete experience, reflective observation, abstract conceptualization, and active experimentation. These experiences should incorporate all four components of the model to be true experiential learning events leading to transformation. An extensive literature review was provided to support the research. Transcendental phenomenology was the methodology used, as researchers were trying to capture the overall essence of the experience. Preceptors from five colleges/schools of pharmacy who practice in a variety of pharmacy practice settings were solicited for the research. Participants were recruited by the college’s experiential administrators. Data collection methods were multifold, including interviews, focus groups, and document analysis. A thorough analysis of data, using modified van Kaam’s method, was completed, along with the synthesis of the data. The findings of this research were discussed in chapter four. Seven themes were identified, which included activities, time, assessments, other healthcare professionals, other learners, enablers of Interprofessional Education (IPE), and confounders of IPE. Additionally, responses to the central and sub-research questions were provided as preceptors described the learning experience provided to students, and activities were identified that promoted the four components of the ELM. Activities that optimize medications and prevent problems are key to shared clinical decision-making. Chapter five concludes with implications, limitations, delimitations, and recommendations for future research

    A qualitative study exploring whether emotion work conducted by health visitors has an influence on their assessment and identification of children in need of care and protection?

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    There is an increased understanding that experiencing adversity in childhood can have a significantly negative impact on the long-term developmental wellbeing of children and young people, as well as their families and communities. Political and societal ambition is that such adverse experiences and their consequences are eradicated through preventative and early intervention measures taken by health, education, and social care practitioners on the identification of a child(ren) who requires support. Professionals working with children have become increasingly proficient in this type of work however no professional is infallible. As a result, many children and young people living with adverse circumstances can go unnoticed. For some this includes experiencing harm which often only comes to light when they have been significantly or fatally injured. Every child living in the United Kingdom is aligned with the universal health visiting service following birth to school entry. Health visitors play an essential role in “searching for health needs” through the “surveillance and assessment of the population’s health and wellbeing” (Nursing & Midwifery Council [NMC] 2004, page 11) . Such universal contact based on these core principles mean that health visitors are ideally positioned to identify children living in challenging situations but, like others, they can find this difficult on occasions. The purpose of this study is to explore whether health visitors view the emotion work they carry out as part of their role has an influence on their ability to assess, identify, and respond to children in need of care and protection. STUDY – METHOD: The study has been progressed qualitatively, using a reflexive ethnographic approach to interviews as the main data collection and analytic method with short periods of office-based observation. 16 health visitors who managed caseloads of between 100-450 pre-school children were observed and interviewed to understand their experiences, values, and beliefs. Gee’s (2014) toolkit was used to critically analyse the discourse shared during the interviews. FINDINGS: The emergent findings demonstrate that health visitors can be conceptualised as ‘applied clinical anthropologists’ in the way they develop relationships with families to gain access to their home environments. The approach taken is to gather information to the depth required for a social, bioecological assessment (Bronfenbrenner 2005) of a child in the context of their family and community system. Health visitors are welcomed by most families and are often successful in assessing and responding to child need. However, at times, the level of engagement necessary can be overwhelming for both the health visitor and parent/carer. This influences the level of child centred assessment obtained. The study has demonstrated that the influences on the work of the health visitor can be interpreted through a complex interplay of theoretical concepts. Firstly, Bourdieu’s “theory of practice” (Bourdieu & Wacquant 1992, page 4) provides the basis on which to understand why challenges and barriers arise during the relational work of the health visitor with the child and family. Secondly, Gross’ (2014) Emotion Regulation Framework and Hochschild’s (1983) theory of Emotional Labour, are utilised to consider how health visitors and families respond emotionally to these challenges. The study then goes on to demonstrate what impact these responses can have on the assessment of children. RECOMMENDATIONS: Implications for practice are that health visitors require increased rates of supervision. This should include an observational element. Educational programmes for health visitors, require a focus on promoting professional wellbeing with learning sessions on unconscious bias. Research and learning developments are suggested to influence assessment and decision-making practice. Research with other professional groups and children & families is recommended to build on the findings of this study in order to influence future safeguarding policy and practice to protect children

    The Impact of Participatory Budgeting on Health and Well-Being: A Qualitative Case Study of a Deprived Community in London

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    Background Participatory budgeting (PB) is a democratic innovation that enables residents to participate directly and collectively decide how to spend public money in their community. Research demonstrates PB improves social well-being through governance, citizens’ participation, empowerment, and improved democracy. Since 2000, PB has increasingly been used in the UK in community development approaches for improving health and well-being outcomes for people living in deprived communities. Yet little is known about how and why PB may impact health and well-being in deprived communities of the UK. This PhD study sought to explore and explain how the application of PB in the Well London programme impacted the health and well-being of people living in a deprived community in London. Methods The study employed a qualitative case study design adopting the constructivist grounded theory (CGT) methodology of Charmaz (2006) to explore critical themes from interviews with stakeholders of the Well London programme in Haringey Borough. Forty-one stakeholders engaged in planning, co-designing, co-commissioning and co-delivering, or benefitted from three interventions commissioned through PB participated in this study between March 2017 and April 2018. Results A cross-case analysis revealed six pathways through which PB improved health, particularly for the underserved. PB maximised participation and meaningful engagement; enhanced direct demand and response to the community’s needs; individual and collective ownership; action on the social determinants of health; and creative partnership working. These pathways were moderated by the democratic and flexible approach of the PB ethos, particularly the inclusion of residents’ voices in the planning and delivery of the interventions. Residents were motivated to act as agents to change their lives by building positive relationships based on social inclusion and integration. As a result, residents’ self-esteem, sense of belonging, self-confidence, self-worth, and individual sense of belonging and community spirit increased. Residents gained a new zeal and agency to tackle the social determinants of health as they understood them in their lives. Conclusion When done correctly, PB can promote health and well-being and build more robust and resilient communities through community-centred democratic decision-making. Interventions should aim to increase critical consciousness, health literacy, and the capacity in deprived communities to tackle life-course issues that prevent residents from enjoying good health and reduce structural barriers to accessing services or interventions to improve health and reduce inequalities. The outcomes of this study have policy and practice implications for strengthening the design, commissioning, and delivery of health interventions in deprived communities of high-income countries

    Dimensions of Transformational Leadership as Predictors of Employee Creativity: The Moderating Role of Job Satisfaction

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    The aim of this research was to determine whether the dimensions of transformational leadership predicted employee creativity, as well as whether job satisfaction strengthened this association through moderation. Findings in the existing literature exhibited mixed outcomes concerning TL’s impact on EC, requiring more empirical research. Many studies have employed moderating variables in search of potentializing a stronger relationship between TL and EC; however, no previous scholars have explored JS’s moderating capabilities between the variables. JS as a suitable strengthening variable between TL dimensions and EC is evidenced through unrelated research concerning TL’s impact on JS and JS’s impact on EC. A quantitative, nonexperimental approach with a survey methodology was curated for this research study. The sample consisted of 183 knowledge-worker employees from creativity-driven organizations. The data were collected via an electronic survey platform (SurveyMonkey) and analyzed (multiple linear regression, formal moderation, simple slope analysis) using SPSS. The findings indicated that TL’s dimension of idealized influence was the most robust statistically significant dimension to predict EC. Furthermore, employee JS moderated the relationship between II and EC at multiple standard deviation levels. The results add to the theoretical and practical implications of the literature by solidifying II’s consistency as an EC influencer, providing a fresh perspective from a new sample in North America, and breaking new ground by exploring employee JS as a moderator. These results open a new view on the criticality of II and employee JS to increase EC. Fostering such concepts can catapult businesses to capitalize on organizational innovation and sustain a competitive edge in the current volatile, uncertain, complex, and ambiguous business landscape

    Job Stress, Anxiety, and Depression in Mental Health Professionals: An Examination of Experienced Vicarious Trauma and Gender Differences

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    AbstractMental health professionals are susceptible to an increased risk of job stress, anxiety, and depression based on the very nature of their work. The study was quantitative, focusing on profile analysis. A two-way MANOVA was performed utilizing the independent variables of gender and vicarious trauma, and three dependent variables of job stress, anxiety, and depression. The population size was 88 mental health professionals with a Bachelor’s degree or higher who work in the behavioral health field, directly servicing clients in the capacity of supervision, case management, social work, counseling, or therapy. Participants completed four self-reported questionnaires: General Work Stress Scale (GWS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and the Trauma and Attachment Belief Scale (TABS). The results of the study indicated that there was no statistical significance of the interaction term of gender and vicarious trauma with respect to the GWS (F = 0.572, p = .45), BAI (F = 0.268, p = 0.60), or BDI-II (F = 1.270, p = .26). The results indicated there was no statistical significance in gender with respect to the GWS scale, BAI, or the BDI-II (F = 0.895, p = .347) (F = 2.870, p = 0.094) (F = 0.134, p = 0.715). In addition, the results did indicate there was a statistical significance in vicarious trauma with respect to the GWS (F = 9.79, p = 0.002), BAI (F = 18.98, p = 0.000), and BDI-II score (F = 38.2, p \u3c .01). The study outcomes may contribute to positive social change, assisting in the development, promotion, and facilitation of awareness training, educational workshops, organizational support systems, and gender-sensitive interventions for mental health professionals

    Strategies to Retain Employees in the Mental Health Workplace

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    Employee turnover continues to be an issue in the mental health community as mental health business leaders lack strategies to retain employees. Retention strategies are essential to promote continuity, funding, and profitability for mental health agencies and quality service care for patients. Grounded in Bass’s transformational leadership theory, the purpose of this qualitative single case study was to explore strategies mental health business leaders use to retain employees. Participants comprised three mental health center managers from a state agency in northern Louisiana who contributed to employee retention. Data were collected using semistructured interviews and a review of organization performance evaluations, hire/rehire audit reports, and turnover analysis reports. Using Braun and Clark’s six-step thematic analysis, three key themes emerged: communication, support, and teamwork. A key recommendation is for mental health business leaders to listen to employees with a sense of respect and value, demonstrate concern, and show awareness. Implications for positive social change include the potential for mental health business leaders to increase job satisfaction, job performance, and retention
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